The Fulkerson osteotomy is an operation to re-align the tibial tuberosity antero-medially to alter the direction of the forces going through the kneecap.
Page updated June 2024 by Dr Sheila Strover (Clinical Editor)
Why realign the tibial tuberosity?
Some patients who are experiencing pain in the front of the knee, or patellar instability, may be found to have poor alignment of the various anatomical structures that allow the knee to straighten.
For example, the attachment of the patellar tendon to the tibia may not line up well with the groove in which the patella tracks.
Realigning the tibial tuberosity (tibial tubercle) is not a procedure to be undertaken lightly because complications are possible.
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Quote from peer-reviewed paper:
"....appropriate patient selection....[is]....paramount."
Citation: Grimm NL, Lazarides AL, Amendola A. Tibial Tubercle Osteotomies: a Review of a Treatment for Recurrent Patellar Instability. Curr Rev Musculoskelet Med. 2018 Jun;11(2):266-271. doi: 10.1007/s12178-018-9482-3. PMID: 29721692; PMCID: PMC5970117.
What is distal realignment?
The Fulkerson osteotomy is one of a group of procedures to realign the patella (kneecap) distally (ie the lower end of the patella-tendon complex).
The tibial tubercle is fixed in its new position with screws.
Other distal realignment procedures include:
- Maquet procedure
- Elmslie-Trillat procedure
- Hauser procedure
- Roux-Goldthwait procedure
- many variants and modifications
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Quote from peer-reviewed paper:
"[Tibial tubercle osteotomy] is a well-described procedure used for realignment of the extensor mechanism....to reduce joint reaction forces and realign problematic contact areas in the setting of patellofemoral joint disorders....However, TTO is not without risk of complications....[such as] osteotomy site nonunion....[and]....tibial fracture...."
Citation: Ridley TJ, Baer M, Macalena JA. Revisiting Fulkerson's Original Technique for Tibial Tubercle Transfer: Easing Technical Demand and Improving Versatility. Arthrosc Tech. 2017 Aug 7;6(4):e1211-e1214. doi: 10.1016/j.eats.2017.04.013. PMID: 29354419; PMCID: PMC5622023.
Forum discussions
- Fulkerson Osteotomy Questions
Brief overview about what to expect from surgery.
- Fulkerson Procedure ?'s
A young person asking about what to expect from this procedure.
- Fulkerson and Screws..anybody had em out?
Talking about screw discomfort and screw removal after a Fulkerson procedure.